
<form name="register" action="register_action.php" method="post">
<table width="368" border="0" cellpadding="5px" style="border-style:solid;" cellspacing="0">
	<tr>
    <td colspan="2"><h2>Register page</h2>
      <p>&nbsp;</p></td>
    </tr>
  <tr>
    <th width="135" scope="row">Full Name</th>
    <td width="217"><label>
      <input type="text" name="name" id="name" size="32" />
    </label></td>
  </tr>
    <tr>
    <th width="135" scope="row">Date of Birth</th>
    <td width="230"><label>
    <select id="day" name="day" style="width:60px;">
   		<option value="day">--day--</option>
    <?php
		for($i=0; $i<31; $i++)
		{
			echo "<option value='".($i+1)."'>".($i+1)."</option>";
		}
	?>
    </select>
    <select id="month" name="month" style="width:75px;">
   		<option value="month">--month--</option>
    <?php
		for($i=0; $i<12; $i++)
		{
			echo "<option value='".($i+1)."'>".($i+1)."</option>";
		}
	?>    
    </select>
    <select id="year" name="year" style="width:70px;">
   		<option value="year">--year--</option>
    <?php
		for($i=1940; $i<2001; $i++)
		{
			echo "<option value='".$i."'>".$i."</option>";
		}
	?>    
    </select>
    </label></td>
  </tr>
  <tr>
    <th scope="row">Address</th>
    <td>
		<input type="text" name="address" id="address" size="32" />
    </td>
  </tr>
  <tr>
    <th scope="row">Username</th>
    <td><input type="text" name="username" id="username"  size="32"/></td>
  </tr>
  <tr>
    <th scope="row">Password</th>
    <td><input type="password" name="password" id="password" size="32" /></td>
  </tr>
  <tr>
    <th scope="row">Retype Password</th>
    <td><input type="password" name="trypassword" id="trypassword" size="32"/></td>
  </tr>
  <tr>
    <td colspan="2"> 
    <input type="submit" name="submit" value="Register" />
    &nbsp;
    <input type="reset" name="reset" value="Clear" />    </td>
  </tr>
</table>
</form>